Intraoperative Application of Ultrasonic Energy to Bioabsorbable Craniosynostosis Fixation Devices and Adverse Tissue Reaction. Is There a Correlation?

Bioabsorbable internal fixation is a well-accepted modality that is especially suitable for application in craniosynostosis. When first introduced, high rates of adverse tissue reactions were observed that have since been ameliorated with more biocompatible polymer formulations. However, the phenomenon has not entirely disappeared, and such reactions remain vexing. It has been suggested that intraoperative use of ultrasonic activation to heat and remodel 50:50 poly(D-lactide-co-L-lactide) fixation devices could potentiate an adverse tissue response following craniosynostosis procedures. The evidence for this was examined based on a clinical literature search, as well as a review of bioabsorbable polymer science principles, to see whether there is a theoretical basis to explain how such a relationship might be possible. Although a trend was evident suggestive of such an association, unequivocal evidence was not found. Also, no obvious potential mechanism that could explain such an association, should it exist, was apparent. The methodological approach used in this analysis and the information presented can help provide a foundation for future analyses of this nature.